【作者】 马强；

【导师】 苏开明；

【作者基本信息】 上海交通大学 ， 耳鼻咽喉科， 2020， 硕士

【摘要】 目的鼻中隔偏曲(Nasal septal deviation,NSD)病人,抑郁焦虑状态的评估及危险因素分析,以及关于“空鼻症”(Empty nose syndrome,ENS)的医患认知调查。方法患者的抑郁状态,焦虑状态,症状负担,及对生活质量的影响,分别使用Zung自评抑郁量表(SDS),Zung自评焦虑量表(SAS),鼻腔鼻窦结局测试22条(SNOT-22)和(或)鼻阻塞症状评估(NOSE)量表等来评估。采用病例对照设计,分析76例门诊NSD患者和79例对照组患者的临床资料,研究鼻中隔偏曲患者的抑郁与焦虑状态;采用横断面研究,纳入101名NSD患者,研究NSD患者抑郁和焦虑的危险因素;通过问卷的形式,对314名医生和136名相关患者分别进行ENS的认知调查。结果鼻中隔偏曲患者的抑郁,焦虑,以及两者的合并症较对照组更常见(39.5%vs22.8%,p=0.025;38.2%vs15.2%,p=0.001;和27.6%vs11.4%,p=0.011);抑郁和焦虑症与鼻中隔偏曲的症状负担得分相关,抑郁组SNOT-22得分高于非抑郁组(51.41±18.92)vs(33.19±17.74)(p<0.001);其中,SNOT-22的睡眠症状子域(Rs=0.522,p<0.001),耳/面部症状(Rs=0.389,p<0.001)和鼻部症状(Rs=0.26,p=0.009)子域与患者的抑郁状态相关。焦虑组SNOT-22得分高于非焦虑组(49.59±21.12)vs(34.60±17.16)(p<0.001)。睡眠症状子域(Rs=0.479,p<0.001),耳/面部(Rs=0.414,p<0.001)和鼻部子域(Rs=0.229,p=0.021)与患者的焦虑抑郁状态相关,而出乎意料的是,自觉效果不好的鼻中隔手术,与抑郁和焦虑状态均无明显相关。多变量分析显示,睡眠症状是抑郁症的独立预测因子(OR:1.06;95%CI:1.01-1.11,p=0.019);耳/面部症状是焦虑症的独立预测因子(OR:1.175;95%CI:1.039-1.329,p=0.010)。在问卷调查研究中,相对于未手术患者,自觉手术效果不好的鼻中隔术后患者,更加关注ENS;而多达59.1%的医生不愿接诊可疑ENS患者;在ENS是否为精神疾病方面,医患分歧明显(60.2%Vs 3.9%)。结论鼻中隔偏曲患者的抑郁和焦虑状况更为常见和严重,这可能与疾病本身的造成的痛苦有关。通过关注患者的睡眠状况及耳/面部症状,有助于及时评估患者的心理状况,从而改善治疗效果。空鼻症的概念,给医患双方造成了严重的心理负担,而医患在疾病根源方面,存在较大分歧,亟待进一步明确。更多还原

【Abstract】 ObjectiveTo evaluate the depression and anxiety status and analyze the relevant risk factors in patients with nasal septal deviation(NSD),and a doctor-patient survey on the perception of empty nose syndrome(ENS)is also involved.MethodsThe patient’s depression status,anxiety status,symptom burden,and quality of life were measured using the Zung Self-Assessment Depression Scale(SDS),Zung Self-Assessment Anxiety Scale(SAS),Sino‐Nasal outcome test‐22(SNOT-22)and / or nasal obstruction symptom evaluation(NOSE)assessment,etc.A case-control design was used to analyze the clinical data of 76 NSD patients and 79 control patients to study the depression and anxiety of patients with NSD;and a cross-sectional study design was used to study the risk factors of depression and anxiety in 101 NSD patients.In the form of questionnaires,314 doctors and 136 patients were separately surveyed on the perception of ENS.ResultsDepression,anxiety,and co morbidities are more common in patients with NSD than those in the control group(39.5% vs.22.8%,p = 0.025;38.2% vs.15.2%,p =0.001;11.4% vs.27.6%,p = 0.011);In the analysis of risk factors,The SNOT‐22 score of the depression group was significantly higher than that of the non-depression group(51.41 ± 18.92)vs.(33.19 ± 17.74)(p <0.001);Correlation analysis showed that the most significant correlation of sleep symptoms subdomain of SNOT-22(Rs = 0.522,p<0.001),followed by ear / facial symptoms(Rs = 0.389,p <0.001)and nasal symptoms(Rs = 0.26,p = 0.009)subdomain.Similarly,the SNOT‐22 score of symptoms in the anxiety group was higher than that in the non-anxiety group(49.59 ± 21.12)vs(34.60 ±17.16)(p <0.001).Correlation analysis showed that the most significant was the sleep symptom subdomain(Rs = 0.479,p <0.001),followed by ear / face(Rs = 0.414,p<0.001)and nasal subdomain(Rs = 0.229,p = 0.021),and unexpectedly,the history of failed nasal septal surgery was not significantly associated with depression and anxiety.Multivariate analysis showed that sleep symptoms were independent predictors of depression(OR: 1.06;95% CI: 1.01-1.11,p = 0.019);ear / facial symptoms were independent predictors of anxiety disorder(OR: 1.175;95% CI: 1.039-1.329,p = 0.010).In the investigation,patients who were not satisfied with the effect of surgery after septoplasty,were more concerned about ENS;and 59.1% of doctors were reluctant to see patients with suspicious ENS.There were obvious differences between doctors and patients regarding whether ENS is a mental illness(60.2% Vs 3.9%).ConclusionDepression and anxiety in patients with NSD are more common and severe,which may be related to the pain caused by the disease itself.Focusing on the patient’s sleep status and ear / facial symptoms may be helpful to assess the patient’s psychological status in a timely manner,which may improve the treatment effect.The conception of ENS has caused a serious psychological burden on both doctors and patients,they have major differences on the root cause of the disease,which needs to be further clarified.更多还原